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Clinical Policy: Voice Therapy Reference Number: HNCA.CP.MP.134 Effective Date: 4/10 Coding Implications Last Review Date: 02/21 Revision Log

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Clinical Policy: Voice Therapy Reference Number: HNCA.CP.MP.134 Effective Date: 4/10 Coding Implications Last Review Date: 02/21 Revision Log Clinical Policy: Voice Therapy Reference Number: HNCA.CP.MP.134 Effective Date: 4/10 Coding Implications Last Review Date: 02/21 Revision Log See Important Reminder at the end of this policy for important regulatory and legal information. Description Voice therapy refers to any non-surgical techniques employed in the management of individuals with voice disorders. The goal is to modify vocal behaviors to reduce or correct maladaptive and inappropriate vocal behaviors and laryngeal trauma. Voice therapy is usually subject to speech therapy benefits. Policy/Criteria I. It is the policy of Health Net of California that voice therapy is medically necessary when provided by a qualified speech language pathologist for the following indications: A. Post vocal cord surgery or vocal cord trauma, or B. Post laryngeal (glottic) carcinoma, or C. Paradoxical vocal cord motion, or D. Functional or spastic (spasmodic) dysphonia, or E. Vocal cord nodules/lesions, or F. Vocal cord paralysis, or G. As part of gender affirming services. II. It is the policy of Health Net of California that voice therapy is not medically necessary to improve voice quality due to such conditions as laryngitis or for occupational or recreational purposes. Background Voice disorders are characterized by pitch, loudness, resonance, quality or duration of voice or by the inability to use one’s voice. The disorders result from abnormal laryngeal, respiratory or vocal tract functioning. Voice therapy includes four major components: vocal hygiene, vocal production, muscle relaxation and respiratory support. Disorders of the vocal cords such as surgical procedures, trauma, cancer, nodules and issues regarding motility (spasm, paralysis) can all affect speech. Vocal cord nodules (singer's nodules) are small, hard, callus like growths that usually appear singly on the vocal cord. Vocal cord polyps are small, soft growths that usually appear singly on a vocal cord. They are most often caused by vocal abuse or long-term exposure to irritants, such as chemical fumes or cigarette smoke. Spasmodic dysphonia (SD) involves difficulty speaking because of repetitive or continuous spasms or dystonia of the muscles that control the vocal cords. SD is an extremely disabling form of dystonia that is often misdiagnosed. In certain scenarios, an underlying neurologic disease must also be ruled out, especially Wilson’s, Huntington’s and Parkinson’s disease which may cause secondary SD. Page 1 of 6 CLINICAL POLICY : Voice Therapy Benign vocal fold lesions are a common cause of dysphonia. Most laryngologists consider voice therapy, often together with medical management, the initial treatment of choice for benign lesions. Many studies have documented good outcomes after voice therapy in patients with a variety of benign lesions. Increasingly, otolaryngologists are using response to voice therapy to help differentiate among benign mucosal lesions, inform the treatment decision for surgery, and optimize surgical outcome. In cases in which surgery is necessary, pre- and postoperative voice therapy may shorten the postoperative recovery time, allowing faster return to work and limiting scar tissue and permanent dysphonia Many laryngologists consider voice therapy essential for patients with unilateral vocal fold paralysis as definitive treatment or as adjunctive to surgery. Evidence suggests that preoperative voice therapy improves voice outcomes for greater than 50% of patients with unilateral vocal fold paralysis and may render surgery unnecessary. In other neurological-based dysphonia, such as Parkinson's disease, voice therapy has yielded significant improvement in overall communication. Clinical trials have (Van Gogh 2006) have shown that voice therapy can be effective in rehabilitating persons treated for early glottic carcinoma. Statistical analyses of the difference in scores (post-measurement minus pre-measurement) showed significant voice improvement after voice therapy by the patients and also confirmed by objective voice parameters. The American Academy of Otolaryngology- Head and Neck Surgery Committee on Speech, Voice, and Swallowing and the Special Interest Division, Voice and Voice Disorders of the American Speech-Language-Hearing Association, have developed the statement noted below, regarding the use of voice therapy in the treatment of dysphonia: “It is the consensus of these committees that voice therapy by a licensed speech language pathologist is important for effective medical and surgical treatment of the patient with dysphonia. Voice therapy should be an integral part of the treatment plan of the patient until optimal patient response is achieved”. Coding Implications This clinical policy references Current Procedural Terminology (CPT®). CPT® is a registered trademark of the American Medical Association. All CPT codes and descriptions are copyrighted 2015, American Medical Association. All rights reserved. CPT codes and CPT descriptions are from the current manuals and those included herein are not intended to be all-inclusive and are included for informational purposes only. Codes referenced in this clinical policy are for informational purposes only. Inclusion or exclusion of any codes does not guarantee coverage. Providers should reference the most up-to-date sources of professional coding guidance prior to the submission of claims for reimbursement of covered services. Page 2 of 6 CLINICAL POLICY : Voice Therapy May not be an all inclusive list CPT® Description Codes 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual [voice therapy] 92508 Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, two or more individuals [voice therapy] 92521 Evaluation of speech fluency (e.g., stuttering, cluttering) 92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria) 92523 Evaluation of speech sound production (e.g. articulation etc) with evaluation of language comprehension etc 92524 Behavioral and qualitative analysis of voice and resonance HCPCS Description Codes G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes ICD-10-CM Diagnosis Codes that Support Coverage Criteria ICD-10-CM Description Code J38.00 – J38.02 Paralysis of vocal cords and larynx J38.2 Nodules of the vocal cords C32.x Malignant neoplasm of the larynx S19.38x+ Other specified injuries of vocal cord F64-F64.9 Gender Identity Disorder Z85.21 Personal history of malignant neoplasm of larynx Reviews, Revisions, and Approvals Date Approval Date Initial Approval 4/10 4/10 Update No Revisions 4/11 4/11 Update No Revisions, coding updates 2/12, 2/13 2/14 2/15 2/16 Placed on new template, approved 9/17 Update with no revisions 9/18 Page 3 of 6 CLINICAL POLICY : Voice Therapy Reviews, Revisions, and Approvals Date Approval Date Update to include gender reassignment and added code 2/19 2/19 Update; references updated 2/20 2/20 Updated CPT codes, added reference, revised gender “reassignment” to 2/21 2/21 gender “affirming” services References 1. Behlau M, Madazio G, Oliveira G. Functional dysphonia: strategies to improve patient outcomes. Patient Relat Outcome Meas. 2015 Dec 1;6:243-53. 2. Busto-Crespo O, Uzcanga-Lacabe M, Abad-Marco A, et al. Longitudinal Voice Outcomes After Voice Therapy in Unilateral Vocal Fold Paralysis. J Voice. 2015 Dec 3. 3. De Bodt M, Van den Steen L, Mertens F, et al. Characteristics of a Dysphonic Population Referred for Voice Assessment and/or Voice Therapy. Folia Phoniatr Logop. 2016 Jan 15;67(4):178-186. 4. Hayes Search & Summary. Voice Therapy for Muscle Tension Dysphonia. July 2013. Archived Aug 2014. 5. Hayes. Medical Technology Directory. Lee Silverman Voice Treatment for Speech and Voice Problems in Parkinson’s Disease. June 28, 2012. Update June 2014. Update May 2015 6. LeBorgne WD, Donahue EN. Voice therapy as primary treatment of vocal fold pathology. Otolaryngol Clin North Am. 2019 May 13 [Epub ahead of print]. 7. Ouyoung LM, Swanson MS, Villegas BC, et al. ABCLOVE: Voice therapy outcomes for patients with head and neck cancer. Head Neck. 2015 Dec 22. 8. Sale P, Castiglioni D, De Pandis MF, et al. The Lee Silverman Voice Treatment (LSVT) speech therapy in progressive supranuclear palsy. Eur J Phys Rehabil Med. 2015 Oct;51(5):569-74. 9. Schwartz SR, Cohen SM, Dailey SH, et al. Clinical practice guideline: Hoarseness (Dysphonia). Otolaryngology–Head and Neck Surgery (2009) 141, S1-S31. 10. Stachler RJ, Francis DO, Schwartz SR, Damask CC, Digoy GP, Krouse HJ, McCoy SJ, Ouellette DR, Patel RR, Reavis CCW, Smith LJ, Smith M, Strode SW, Woo P, Nnacheta LC. Clinical Practice Guideline: Hoarseness (Dysphonia) (Update) Executive Summary. Otolaryngol Head Neck Surg. 2018 Mar;158(3):409-426. 11. Tang SS, Thibeault SL. Timing of Voice Therapy: A Primary Investigation of Voice Outcomes for Surgical Benign Vocal Fold Lesion Patients. J Voice. 2016 Jan 14. 12. Trajano FMP, Almeida LNA, de Alencar SAL, et al. Group voice therapy reduces anxiety in patients with dysphonia. J Voice. 2019 Apr 9 Epub ahead of print]. 13. Van Gogh CD, Verdonck-de Leeuw IM, Boon-Kamma BA, et al. The efficacy of voice therapy in patients after treatment for early glottic carcinoma. Cancer. 2006;106(1):95-105. 14. White A. Management of benign vocal fold lesions: Current perspectives on the role for voice therapy. Curr Opin Otolaryngol Head Neck Surg. 2019;27(3):185-190. 15. Wight S, Miller N. Lee
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